Through this commitment, One HEART will work to reduce maternal and newborn morbidity and mortality in indigenous and underserved populations that experience high rates of home deliveries and high rates of maternal and newborn mortality in Nepal and Mexico. One HEART will partner with existing local organizations in these areas working toward the same commitment but lacking the requisite training, resources, and support. The project in Mexico will be launched in the winter of 2010 and the project in Nepal in late spring 2010. Between these two sites, One HEART will collectively train 300 outreach providers per year, beginning in 2010.
One HEART's Board and Executive Director spent the summer months of 2009 exploring opportunities to introduce the PAVOT model to the Baglung District in Nepal and the Tarahumara Indians in the Copper Canyon of Chihuahua, Mexico. These areas and peoples are being considered because they meet criteria defined in One HEART's 2009 Business Plan and detailed in a project matrix created by One HEART's medical advisory board. One HEART's Executive Director, Tibet Programs Manager, and Research and Evaluation Manager traveled to Kathmandu in July 2009 to meet with prospective in-country partners. One HEART has also funded a three-month feasibility study in Mexico that concluded in August 2009. One HEART's Board of Directors has approved starting with two small projects, one in Nepal and one in Mexico, with staggered start dates.
The world's leading nations and development institutions have agreed to the United Nation's eight Millennium Development Goals (MDGs). One HEART is uniquely positioned to help achieve the UN's fifth MDG - to reduce by two thirds the mortality rate among children under five - by improving maternal and newborn health.
Since 1998, The One Heart World-Wide (OHW) vision has been to create programs and services for the betterment of global maternal and child health. While working among remote populations in Tibet, OHW has developed an innovative program, Pregnancy and Village Outreach Training (PAVOT) for outreach into remote and resource-poor communities. PAVOT aims to improve the health and well-being of pregnant women and newborns that may not otherwise have access to medical or public health services due to socio-cultural barriers, limited personal resources, or living remotely. PAVOT disseminates basic life-saving knowledge, skills, and resources to key community members and, through them, to the pregnant women and families they serve. Experienced PAVOT master trainers employed by One Heart World-Wide train rural health workers and laypersons (called outreach providers). Outreach providers then deliver health education, hands-on training, and materials to the homes of rural women and their families in 'training encounters.' The significance of the PAVOT model is that it offers developing countries an established and proven method to reduce birth-related deaths and it has promise for global implementation, as it is culturally sensitive, replicable, and sustainable. Through PAVOT, OHW will work with partners to provide supplies and skills training on maternal and neonatal health to local populations in order to create sustainable projects. Expanding the culturally sensitive and sustainable PAVOT model to new areas is now a priority for OHW and has received strong interest and acclaim from funders and OHW is now ready to implement its PAVOT model in Mexico and Nepal and is preparing for a 2011 implementation in China.
Mexico: One Heart World-Wide's (OHW) programs in Mexico center on the indigenous population of the Sierra Tarahumara in the Copper Canyon Area of Mexico. A 2009 OHW needs assessment among the Tarahumaras established that the average number of births per women was 5 and almost 90% of all births were unattended by a medical professional. Among the women who delivered without a medical professional, 30% delivered entirely alone. Most houses were at least 3 hours away from the nearest clinic or hospital and 40% of all families were uninsured. The maternal mortality ratio was 998/100,000 live births. The mortality rate among children under 5 years was 40%, and among these, 27% died in the neonatal period (between birth and 28 days of life). Based on OHW's results, they can see that pregnancy, birth and postpartum recovery in the Sierra Tarahumara are still very dangerous for indigenous women and their offspring. While the primary cause is the lack of access to care, distance to medical facilities is not the only barrier to care. Three other important barriers include (1) the Tarahumara's fear (based on facts) that medical providers will disrespect them, violate their right to make informed medical and family planning choices, and otherwise mistreat them; (2) the total lack of trained traditional birth attendants within this population; and (3) other Tarahumara-specific cultural barriers such as the closed nature of the Tarahumara people, the belief that childbirth is a natural process and not a sickness necessitating a doctor's treatment, and machismo that prevents women's freedom to make reproductive health choices for herself.
Nepal: One Heart World-Wide's (OHW) programs in Nepal are located in the Baglung district of Western Nepal where a majority of women have no pregnancy-related contact with modern health services and the status of maternity services is very poor, under-utilized and low in quality. The maternal mortality ratio (MMR) is 539 maternal deaths per 100,000 live births and the perinatal mortality 75 dead infants per 1,000 live births. About 90% of all deliveries occur in a home setting (versus a health care setting). Skilled attendance at delivery is a key factor to reduce maternal and perinatal deaths but while 44% of women receive some type of antenatal care from a skilled birth attendant (SBA) such as a doctor, a nurse or a midwife, only 29% of pregnant women make antenatal care visits during their entire pregnancy, and less than 19% of all births took place with the assistance of a SBA. Unattended delivery, which puts both mothers and newborns at risk for excess morbidity and mortality; in Western Nepal where 67% of maternal deaths take place at home and a further 11% on the way to hospital. The leading cause of maternal death is post-partum hemorrhage (or severe bleeding, a pregnancy complication that can be treated even in basic health centers) and accounts for almost half (47%) of all maternal deaths.
China: One Heart World-Wide's (OHW) brand new program in China is based in Qinghai Province is one of the poorest provinces in the People's Republic of China. Villages, many of which are within the Province's Tibetan prefectures, are remote and scattered throughout a high-altitude, challenging, and fragile landscape. Risks to maternal and child health are high in remote these Tibetan communities, with poor access to transportation, medical facilities, trained health personnel, and with few resources that promote healthy pregnancies and births. The Second Affiliated People's Hospital of Qinghai Medical University, located in Xining, is a large obstetrical hospital that provides routine and high risk care, including outreach as feasible to remote Tibetan communities when an obstetrical emergency occurs. The Second Affiliated Hospital often lacks the human resource and technical capacity to respond to immediate obstetrical needs of its population, including those women living in remote, isolated communities. Strengthening the capacity of the Second Affiliated Hospital to effectively provide obstetrical care in its own institution and to provide outreach and support for emergencies in remote communities are priorities in Qinghai.
SEEKING: Over the next 5 years, One Heart World-Wide (OHW) is seeking a wide range of collaborating partners including financial and/or other material resources donors as well as networking/ and marketing opportunities. We are a small organization with high impact and a big heart that needs to increase public awareness and raise more funds to serve the most isolated defenseless women.
OFFERING: Implementing partners, best practice opportunities. One Heart World-Wide (OHW) has developed a safe motherhood model that is unique and has been successful in the most challenging environment in Tibet. They feel this model can safe lives and would like partners who would be willing to adapt the model. OHW has a team of experts in Maternal Child Health who can lend guidance to others who are developing best practice models on MCH.